HIGHLIGHTS:

Eliminating the need for some medications could improve quality of life.

If you've had a heart attack, or have a heart condition like atrial fibrillation, you may need to take medications for the rest of your life. But are you taking too many? Growing debate questions the safety of polypharmacy and the use of more prescription medications than necessary. Experts point out that the number of drugs you need to take and for how long really depends on your lifestyle and medical history.

By taking an active role in your care and focusing on ways to prevent heart disease, you may be able to eliminate the need for certain drugs and improve your quality of life.

"It's easy to start someone on a drug, but very hard to take someone off," says Curt D. Furberg, MD, PhD, professor emeritus in the division of public health sciences at Wake Forest Baptist Medical Center in Winston-Salem, N.C. Dr. Furberg also served as the head of the Clinical Trials Branch at the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health (NIH) for 12 years. "The problem becomes a bigger issue as people age," adds Furberg.

Taking multiple drugs is particularly prevalent among people with heart disease. For example, about 5 million people in the United States have heart failure, according to the National Heart, Lung, and Blood Institute of the NIH. They may each be prescribed 10 or more heart failure drugs to treat their condition. And it is common to have multiple conditions, like both atrial fibrillation (afib) and heart failure — which is a major complication of afib.

Common Drugs for Heart Disease

Anticoagulants or blood thinners. These drugs are used to prevent harmful clots from forming in the blood vessels and include warfarin, as well as newer medications dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). These medications may treat atrial fibrillation to reduce risks of stroke.

Antiplatelet agents. These medications prevent clotting after a heart attack or in certain forms of heart disease. If you have angioplasty to open a narrow or blocked artery and your surgeon places stents in weak arteries to support their inner wall, antiplatelet agents help prevent clots from developing in the stents. Antiplatelet agents include aspirin, ticlopidine, and clopidogrel.

ACE Inhibitors (angiotensin-converting-enzyme inhibitors). These drugs improve blood flow, making the heart's job easier. Among the available ACE inhibitors are benazepril, captopril, enalapril, fosinopril, and lisinopril.

Cholesterol-lowering drugs. Statins are the best known of these drugs, used to reduce triglyceride levels as well as LDL or "bad" cholesterol levels and increase HDL or "good" cholesterol. Millions of Americans take statins to prevent heart disease. Statins include drugs such as rosuvastatin, atorvastatin, pravastatin, and simvastatin. Other non-statin options for cholesterol lowering include nicotinic acid (niacin), gemfibrozil, and clofibrate.

Additional Drugs for Heart Disease. These may include diuretics (also called water pills) to rid the body of excess fluids and ease the workload for the heart. Another common medication is the calcium channel blocker, used to interrupt the flow of calcium into the heart and blood vessels and possibly help the heart pump with less force and relax the blood vessels. Nitrates are drugs which also reduce the workload of the heart, by relaxing blood vessels, and boosting the supply of blood and oxygen to the heart.

Drugs Being Called Into Question

When patients are on other medications for underlying conditions, such as diabetes, decisions about medications get much more complicated, says James Horowitz, MD, board-certified cardiologist with NewYork-Presbyterian Hospital and assistant professor of medicine at Weill Cornell Medical Center in New York City. Evidence shows that some heart medications have serious side effects that outweigh their benefits, while others may not be as effective as once thought.

Research involving niacin, a commonly prescribed cholesterol-lowering medication, revealed that the adverse effects of the drug could offset any potential benefits. A study, known as the HPS2-THRIVE trial, randomly assigned more than 25,000 patients to receive niacin or a placebo. The research showed that those taking niacin had a higher risk of muscle damage and developing diabetes.

Risks Associated With Too Many Drugs

The more medications you take, the greater your risk for adverse effects.

The FDA cautions that memory loss, forgetfulness, and confusion were reported by some statin users. Patients on statins may also be at greater risk for type 2 diabetes. The FDA added that some medications interact with lovastatin and can increase the risk of muscle damage. Although the benefits of statins have been clearly established, the agency concluded doctors should be aware of all possible side effects when prescribing these drugs.

Moreover, taking both aspirin and the drug clopidogrel increases the risk of bleeding side effects. A 2013 study concluded the use of clopidogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of blood clot formation.

"The more medications patients are taking, the more likely they are to become overwhelmed," Dr. Eisenberg pointed out. "Sometimes patients are not sure which medication is causing a particular side effect, and they stop taking all of them."

By cutting back on less-effective drugs, you can reduce side effects and costs and may increase the benefits, according to Furberg. "There are a lot of medications that are available to be used. The question is which ones are the most important for each patient. After you use two or three, what is the added benefit of a fourth?" he explains. "Physicians should be conservative and cut back on the drugs with questionable value and focus on those clearly documented to change health outcomes."

"When I see a patient for a second opinion, instead of adding drugs, I think about what I can subtract," Eisenberg adds. "All care needs to be individualized. You need to treat the patient, not the problem."

Take an Active Role in Your Care

Focus on prevention. Follow up with your doctors and ask about lifestyle changes that can help you get off certain medications, says Horowitz. Losing just five pounds may help some patients get off blood pressure medication, Eisenberg points out. Exercise and quitting smoking are lifestyle changes that can help reduce the need for medications.

Get informed. Whenever you go to see any doctor, bring along a list of all your medications, says Horowitz. "Patients should be their own advocates. They need to know why they are on each pill," he says.

Ask for help. Furberg advises older patients to get their friends or family involved to help them keep track of their medications. Horowitz recommends using a pillbox divided by days of the week to help ensure you take your medications correctly.

Above all, communicate with your doctor. Address any concerns you have about your treatment plan, advises Horowitz. "If taking too many prescriptions is compounding pre-existing health issues, it may be time to engage in a frank discussion with your doctor regarding the necessity of each medication," he says.

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here.